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Torn knee ligament

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Ligaments perform the most important functions of connection, amortization and stabilization in the joint. Knee ligaments provide painless and smooth extension-flexion movements. Natural elasticity allows the ligaments to adapt loading and cushion the joint in case of excessive movements. Therefore, knee injuries often include ligament tears.

Patogenesis

Ability of ligaments to stretch is not limitless. When the allowable range of movements is exceeded, tissues can tear. High strength leads to the violation of fiber integrity and a rupture occurs.

Not only professional athletes can face this situation. Ligament injuries often result from an inaccurate, involuntary movement of the knee, as well as from a direct blow to the joint. Knee ligament tear symptoms and possible consequences depend on the point of impact and complexity of the injury.

The most common types of knee ligament injuries include:

  • collateral ligament tear (outside ligaments)
  • cruciate ligament tear (internal ligaments)

Injuries of the lateral collateral ligament (LCL) are mostly caused by a direct blow to the knee from the outside when the leg is bent.

With indirect injuries, a medial (inner) lateral ligament (MCL) tear occurs.

When stumbling or slipping, you lean back. In this case, torsion in the knee join happens, while the foot and shin do not move, which causes a tear of the inner ligament.

Such traumas lead to numerous knee problems. Along with the tear of the medial ligament, the meniscus also can be damaged or the anterior cruciate ligament (ACL) is torn.

Women who wear high heels often face a partial tear of the medial ligament.

An anterior cruciate ligament tear in the knee joint is associated with blows from the back with the shank bent. Even a partial tear of ACL leads to instability of the joint.

If you leave the partial ACL tear unattended for a long time, you may develop arthritis of the knee.

A partial posterior cruciate ligament tear occurs in case of a direct blow to the knee or shin from the front side, when the leg is bent.

A full or partial tear of the posterior cruciate ligament often occurs together with an anterior ligament injury and medial collateral ligament tear that can also follow with meniscus injuries. This triple combination is often called “unhappy triad”, or O'Donoghue's triad.

Anterior Cruciate Ligament Surgery

The anterior cruciate ligament (ACL), which connects the femur with the shin, is one of the ligaments of the knee joint. ACL carries the load on the knee joint and helps prevent the joint from displacement. Furthermore, together with other ligaments, it reduces the knee joint rotation.

The tear of the anterior cruciate ligament joint is one of the most common injuries. Mostly, it occurs in sports such as football, hockey, basketball and downhill skiing, all of which are in a high risk of injury. The ACL tear is mainly caused by a combination of rotational trauma and knee injury. In 50% of cases, the ACL injury is accompanied with meniscus and articular cartilage injuries, and tear of other ligaments.

Common complaints

When the anterior cruciate ligament tears, you may hear a popping sound in the knee, while bleeding into the knee joint may lead to edema that increases with physical exertion. It becomes difficult to bend and straighten the knee. After the acute symptoms are relieved a little, the patients experience a feeling of instability of the knee joint which is usually expressed in complaints for insecurity in the knee joint, buckling of the knee and difficulties to control the joint, especially, at a sudden stop or when turning the leg. Due to changes in biomechanics, this instability leads to an extra load to the knee joint and, sooner or later, to secondary injuries of the meniscus and cartilage tissues.

Diagnosis

For successful treatment, you need a targeted clinical examination. MRI is done to exclude concomitant traumas, such as meniscus injuries, and determine strategy of treatment. Accurate diagnosis plays an important role when surgery is considered.

Treatment of the Anterior Cruciate Ligament

Conservative Treatment

Surgery is not always required in case of anterior cruciate ligament tear. Depending on complaints, the degree of instability in the knee joint, the presence of concomitant injuries and the patient's age, an individual treatment regimen is selected. With conservative therapy, the main goal is to strengthen the muscles and restore the normal mobility of the joint as soon as possible.

Surgery

For physically active patients, stabilizing the knee joint is extremely important. During arthroscopy of the torn anterior cruciate ligament, the following options are available: reconstruction of the anterior cruciate ligament with the tendons of the semitendinous and gracilis muscles; removal of the damaged part of the meniscus and stitching; cartilage transplantation, etc. Treatment of concomitant injuries can be performed simultaneously with the main procedure.

Repeated Tear of the Cruciate Ligament (after Cruciate Ligament Plastic Surgery)

In case of repeated tear of the cruciate ligament after plastic surgery, we mainly use tendons of the semitendinous and gracilis muscles from the opposite side for a patellar tendon graft. Depending on the location of a hole drilled and its width, it is, first, necessary to fill a canal with spongy bone from the iliac crest. After this, repeated plastic surgery of the cruciate ligament can be performed in 3-6 months.

Surgery Stages

  1. Consultation
    • Examination
    • MRI
    • Diagnosis
    • Working-out the treatment
    • Prescription for blood thinners (e.g. Aspirin, Plavix, Marcumar, etc.)
  2. Preparation for surgery:
    • Discussing with a patient
    • Anesthesia planning
    • Blood test
    • MRI (KT 1000)
  3. Moving to a hospital
    • on the day of surgery
  4. After surgery
    • Average length of stay in the hospital is about 2 to 4 days
    • A patient tries walking and exercising already in the 1st day after surgery
    • Plaster cast is applied for about 2 days and, then, a knee joint stabilizer is used up to 6 weeks
  5. Main goals:
    • to reduce swelling
    • to restore mobility and coordination completely
  6. Exercising in order to
    • restore the joint mobility

Combined methods

Using leeches for hematomas

Hirudotherapy is a non-traditional method of treatment. Thanks to it, local stasis of blood and pain can be eliminated, and an anti-inflammatory effect is achieved.

Indications

  • Osteoarthritis of the knee / hip / carpal joint
  • Pain in the lumbar spine, neck pain, or herniation of the intervertebral discs
  • Stretching / bruising / tears of muscles
  • Inflammations:
    • Bursitis
    • Tendovaginitis
    • Abscess / boils
    • Gout
  • Other symptoms, such as tinnitus, shingles, varicose veins, and acute thrombosis (thrombophlebitis)
Acupuncture for Edema

Acupuncture with needles stimulates certain points on the human body. The energy in the body starts flowing in the right direction, which compensates the imbalance between body systems.

Frequent Asked Questions

What to do after the surgery?

Only limited physical activity is recommended for 2 weeks after surgery. Then, if there is no pain, the physical exertion can be increased. For about 6 weeks, it is recommended to wear a knee joint stabilizer. It is also necessary to prevent thrombosis. After discharge, a patient is prescribed an outpatient physiotherapy (a smooth transition to it is planned in advance). In the first weeks, the main focus is on the restoring mobility of the knee joint. Starting from the 7th week, you can increase the load when exercising to strengthen the muscles.

When can I do sports again?

This is individual. As a rule, if there is a good mobility of the knee joint, it is possible to start training on a stationary bike starting from the second week after the surgery, swimming – from 6th weeks, and jogging – from the 12th week. You can do contact sports, such as football, basketball, etc. not earlier than 8 months after the surgery.

When can I drive again?

Driving is not recommended immediately after eliminating pain and restoring the mobility of the knee joint. It should be also noted that you cannot drive a car if you have a knee joint stabilizer.

Posterior Cruciate Ligament Surgery

There are two crossing ligaments in the center of the knee joint: anterior cruciate ligament and posterior cruciate ligaments. They are located between the upper articular surface of the tibia and the head of the femur and serve to stabilize the knee joint. The posterior cruciate ligament prevents the shin from displacement back relative to the hip and, thus, together with the anterior cruciate ligament, it is responsible for the stability of the knee joint.

Common Causes of Injuries

Injuries of the posterior cruciate ligament are much rarer than anterior cruciate ligament tears. In case of a posterior cruciate ligament injury, knee stability usually restores by scarring. This injury happens when you fall and the shank is displaced backward by force. The most common cause of the posterior cruciate ligament tear is doing sports, especially, football or basketball, as well as mountain skiing and skating. Often, the trauma is preceded by a sudden change in the movement direction caused by an external impact, for example, a blow in a single combat or fall.

Common complaints

When the posterior cruciate ligament tears, you may hear a popping sound in the knee, while bleeding into the knee joint may lead to edema that increases with physical exertion. It becomes difficult to bend and straiten the knee. After the acute symptoms are relieved a little, the patients experience a feeling of instability of the knee joint, which is usually expressed in complaints for insecurity in the knee joint, buckling of the knee and difficulties to control the joint, especially, at a sudden stop or when turning the leg. Due to changes in biomechanics, this instability leads to an extra load to the knee joint and, sooner or later, to secondary injuries of meniscus and cartilage tissues.

Consequences: instability in the knee caused by the tear of the posterior cruciate ligament results from the displacement of the upper and lower parts of the hip joint. This unwanted sliding of the articular surfaces towards each other causes meniscus wear and, over time, can lead to arthrosis.

Diagnosis

After elucidating the circumstances of an accident and examining a patient, it is necessary to conduct the clinical assessment. Due to severe pain, the new tear of the posterior cruciate ligament is more difficult to treat than the one obtained some time ago. An experienced physician can diagnose a displacement of the shank toward the hip using various tests (for example, the drawer test). Comparing the injured knee with the healthy one also plays an important role.

To exclude the possibility of a fracture, you also need X-rays. If there is any suspicion of a concomitant injury, for example, damage to the cartilage or torn meniscus, it is recommended to have an MRI.

Treatment

Not all posterior cruciate ligament tears require surgery; the decision for surgery depends on a few factors and is always discussed with the patient. Depending on the complaints, the degree of instability of the knee joint, concomitant injuries and the patient's age, an individual treatment regimen is selected. The main criteria are the degree of instability and the patient’s feeling of knee instability. In addition, other knee joint damages and disorders, concomitant injuries, ability to rehabilitate, profession and sports that the patient do are taken into account. If, after the injury, the patient has only slight instability in the knee, surgery is not required.

When there are no indications for surgery, training for coordination is assigned to stabilize the knee muscles. This works together with so-called conservative therapy, when the tear of the posterior cruciate ligament heals well without surgical intervention. In case of surgery, tissues of the torn posterior cruciate ligament are replaced, most often with a tendon graft taken from the semitendinous and gracilis muscles or patella tendons. Treatment of concomitant injuries can be performed in the same surgery.

Surgical Treatment of the Posterior Cruciate Ligament

Today, arthroscopy is mostly used for intervention. This minimally invasive surgical method allows avoiding deep incisions to open the knee joint. Through two small incisions (one in a shin and another one in a thigh bone), the tendon is transplanted directly to the knee joint.

This tendon graft serves as the cruciate ligament and grows in the course of the healing process. Stabilizing the tendon immediately after surgery helps maintain sufficient stability and the ability to bend the knee and carry the load to the joint. This surgical method significantly shortens the rehabilitation period and lessens post-operative pain. After the surgery only minor scars remain.

Surgery Planning
  1. Consultation
    • Examination of a site of injuiry
    • Clinical assesment
    • MRI
    • Diagnosis
  2. Preparation for surgery:
    • Surgery plan confirmation
    • Assignment of blood thinners (Aspirin, Plavix, Marcumar, etc.)
    • Blood test
    • Discussing details with the patient
    • Anesthesia planning

Combined methods

Using leeches for hematomas

Hirudotherapy is a non-traditional method of treatment. Thanks to it, local stasis of blood and pain can be eliminated, and an anti-inflammatory effect is achieved.

Indications
    • Arthrosis of the knee / hip / carpal joint
    • Pain in the lumbar spine, neck pain, or herniation of the intervertebral discs
    • Myogeulosis
    • Stretching / bruising / tears of muscles
    • Inflammations:
      • Bursitis
      • Tendovaginitis
      • Abscess / boils
      • Gout
    • Other symptoms, such as tinnitus, shingles, varicose veins, and acute thrombosis (thrombophlebitis)
Acupuncture for Edema

Acupuncture with needles stimulates certain points on the human body. The energy in the body starts flowing in the right direction, which compensates the imbalance between body systems.

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